Analysis of Metastatic Spine Disease Questionnaires

Relevant questionnaires for various assessments of metastatic spine patients exist, but few are well-validated. They have not been studied to assess their relative strengths and weaknesses for evaluating and quantifying quality of life, functional outcome and pain.

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In a study published in The Spine Journal, Massachusetts General Hospital researchers determined which of the following are optimal for evaluating metastatic spine patients:

• Oswestry Disability Index (ODI) or Neck Disability Index (NDI)
• Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function
• PROMIS Pain Intensity
• EuroQol-5 Dimensions (EQ-5D)
• Spine Oncology Study Group Outcome Questionnaire (SOSG-OQ)

As part of the study, 100 patients completed these surveys in random order on a tablet before and after a surgeon visit. Once scored, the team evaluated whether the various questionnaires’ results correlated with each other, were reliable and accurate, and the time they took to complete. Several baseline patient characteristics were collected including age, sex (half of patients were female), ethnicity, educational background, marital status and medical history, including cancer type and spine region affected.

Most (96) patients were Caucasian and had an average age of 63 years. Close to half (46) of the patients were enrolled after spine surgery, while 54 patients received local radiotherapy before enrollment.

A variety of statistical analyses were used to evaluate the results. They evaluated measurement reliability using item response theory. A standard error of measurement (SEM) was deemed 0.32, with values below this indicating measurements were precise; those with values above had a degree of error deemed imprecise. To assess pairwise associations, the Spearman rank correlation coefficient was used, with a correlation coefficient above 0.7 considered to be strong.

The team investigated floor or ceiling effects, with an ideal of having none. And, they evaluated completion times between questionnaires and inter-questionnaire differences using the Friedman test and Wilcoxen signed-rank test, respectively.

The measurements of all questionnaires were determined to be effective for the variables they specifically evaluate, as they demonstrated high correlations (>0.7).

When looking specifically at the various variables, differences emerged between questionnaires. The EQ-5D, a non-disease-specific survey that is often used to measure quality of life and is quick and cost-effective, was the least reliable, with total scores across a range of abilities above the SEM of 0.32. The PROMIS Physical Function and PROMIS Pain Intensity proved to be the most reliable.

A floor effect was found in the PROMIS Pain Intensity (7.0%), ODI or NDI (4.0%), and the PROMIS Physical Function (1.0%), and a ceiling effect was present in the EQ-5D (6.0%), but neither was revealed in the SOSG-OQ. Completion times were longest for SOSG-OQ (at 3 to 4 minutes) and shortest for the PROMIS Pain Intensity (median 24 seconds) and PROMIS Physical Function (median 42 seconds).

When assessing all variables of reliability, lack of ceiling effects and completion time, the SOSG-OQ was deemed most useful for measuring quality of life, the PROMIS Physical Function for physical function, and the PROMIS Pain Intensity for pain. The PROMIS Physical Function Cancer Bank topped the NDI and ODI (which is increasingly being used) in both reliability and completion time.

Based on this study, the research team does not recommend use of the SOSG-OQ sub-domains for physical function and pain due to poor coverage and reliability.

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